Risk factors and pathophysiological insights into optic neuropathy after rhegmatogenous retinal detachment repair: A literature review

Optic neuropathy is an underrecognised but vision-threatening complication following rhegmatogenous retinal detachment (RRD) repair, even when anatomical success is achieved. Several mechanisms have been implicated, including intraoperative light toxicity, mechanical stress on the optic nerve, postoperative elevation of intraocular pressure (IOP), and reduced ocular perfusion pressure (OPP). Tamponade agents such as silicone oil and expansile gases may further contribute to IOP spikes and ischaemic optic nerve injury. Systemic factors, including diabetes, hypertension, and hypercoagulability, can impair vascular autoregulation, increasing susceptibility to ischaemia. Although optical coherence tomography (OCT) and magnetic resonance imaging (MRI) can detect early structural or functional injury, standardised diagnostic and preventive approaches remain limited. In this narrative review, we evaluated evidence from case reports, small case series, retrospective cohort, and case-control studies to outline the incidence, risk factors, and proposed pathophysiological mechanisms of post-RRD optic neuropathy. We also highlight areas of controversy, including the relative contribution of pars plana vitrectomy versus scleral buckle and the potential neurotoxicity of silicone oil, and we discuss the strength of evidence supporting each risk factor. Defining high-risk patients, optimising perioperative IOP control, and evaluating neuroprotective and monitoring strategies represent key priorities for future research.